NEW PNEUMONIA CASE MANAGEMENT GUIDELINES. By Andolo Miheso,Christine Wambugu, Sophie Ngugi, Warfa Osman (NCAHU MOH) & Ambrose Agweyu (KWT)

Transcription

1 NEW PNEUMONIA CASE MANAGEMENT GUIDELINES By Andolo Miheso,Christine Wambugu, Sophie Ngugi, Warfa Osman (NCAHU MOH) & Ambrose Agweyu (KWT)

2 Outline of the presentation: Overview of Child Health situation in Kenya Burden of pneumonia Global /National efforts against pneumonia Evidence for change of pneumonia guidelines Current pneumonia guidelines Revised pneumonia guidelines ROAD MAP

3 Kenya Child Mortality Indicators (KDHS 2014) Under five mortality Rates 52 per 1000 live births Infant mortality Rate 39 per 1000 live births Neonatal Mortality Rate 22 per 100live births MMR : 358/100,000

4 PNEUMONIA Pneumonia is among the leading causes of death in children under five years In Kenya, it is currently responsible for 16% of under five deaths 05/05/2017 4

5 Kenya, Regional & Global picture on Diarrhoea, Pneumonia & Malaria Mortality 25% 21% 20% 15% 10% 17% 15% 16% 14% 18% 11% 18% 8% 5% 0% Diarrhoeal diseases Pneumonia Malaria Kenya Africa Global Source: World Health Statistics 2011, WHO 5 May

6 NATIONAL EFFORTS AGAINST PNEUMONIA (KAPPD): Key Strategies Policy and Budget Environment Management of Common Childhood Illnesses Develop policies and strategies that increase the provision of quality health and nutrition services for children Continuously explore different financial mechanisms to improve access to MNCH services Scale up IMNCI and nutritional support at facility level Scale up IMNCI and nutritional support through community strategy Scale up use of ORS and Zinc for diarrhoea Scale up use of antibiotic treatment for pneumonia Increase uptake of routine services by non attendees through social mobilization Introduce new vaccines such as rotavirus and pneumococcal vaccines Access to Health Services Improve procurement and distribution of essential medical supplies by Mothers and Children Human Resources Strengthen and integrate MNCH components within pre-service and in-service training Strengthen CHWs knowledge and skills for improved MNCH care Communication and Advocacy Strengthen community mobilization and advocacy for the utilization of available services Build community and facility health worker skills capacity in midwifery, essential newborn care, IMNCI and nutrition Develop advocacy and communication strategies for MNCH

7 AMOXICILLIN DISPERSIBLE TABLET The first line Therapy for Pneumonia for children under Five years: Evidence Base.

8 WHO (2005) Hospital Guidelines for Management of Children with Cough / Difficulty in Breathing Syndrome Very severe pneumonia Severe pneumonia Pneumonia No Pneumonia Clinical Signs Any one of: cyanosis, grunting (infants), inability to drink, head nodding, altered consciousness, vomiting everything Lower chest wall indrawing AND without signs of very severe pneumonia Fast breathig (RR /i if age - oths; /i if age months) AND without signs of severe or very severe pneumonia None of the signs of non-severe, severe or very severe pneumonia Inpatient Injectable penicillin + Gentamicin + oxygen, feeds/fluid support Inpatient Injectable penicillin only Outpatient Oral co-trimoxazole Outpatient No antibiotics

9 Child Health Evidence Week: Should benzyl penicillin should be replaced with amoxicillin for the treatment severe pneumonia? Strongly Reject Neither Reject nor Support Strongly Support

10 Amoxicillin vs benzyl penicillin for indrawing pneumonia in Kenyan children: a pragmatic trial Treatment Group Amoxicillin 20/260 (7.7) Treatment failure 48 hr (%) Benzyl penicillin 21/261 (8.0) Risk Difference (95% CI) -0.3% (-5.0, 4.3)* *Non-inferiority margin 7%

11 Primary Evidence: Treatment Failure Study ID Risk Difference (95% CI) Events Amoxicillin Events Penicillin Weight Addo Yobo (-0.03, 0.04) 167/ / Hazir (-0.03, 0.01) 77/ / Agweyu (-0.05, 0.04) 20/263 21/ Overall (I-squared = 0.0%, p = 0.773) (-0.02, 0.01) 264/ / NOTE: Weights are from random effects analysis Favours amoxicillin Favours benzyl penicillin (-0.02, 0.01) 264/ /

12 Pneumonia Guideline Meeting October 2014 Ministry of Health Republic of Kenya. Basic Paediatric Protocols February 2016

13 Revised Kenyan / WHO Pneumonia Guidelines Syndrome Severe pneumonia Pneumonia Pneumonia No Pneumonia Clinical Signs Any one of: cyanosis, grunting (infants), inability to drink, head nodding, altered consciousness Lower chest wall indrawing AND without signs of very severe pneumonia Fast breathig (RR /i if age - oths; /i if age months) AND without signs of severe or very severe pneumonia None of the signs of non-severe, severe or very severe pneumonia Inpatient Injectable penicillin + Gentamicin + oxygen, feeds/fluid support Outpatient No antibiotics

14 AMOXYL DT -ROAD MAP Research on Oral Amoxyl DT Dissemination of research findings PPB included Amoxyl DT in KEML Amoxyl DT in KEMSA LIST National stakeholders sensitization County teams sensitization 3 Counties and hospitals in CIN Network already using Amoxyl DT- Turkana, Siaya & Homa Bay- 1 year supply Local manufacturing KEMSA in process of Procurement National Launch by 1 st July invite KPA

15 Challenges in Implementation Inadequate funding for child health Weak commodity management system leading to stock outs Inadequate synergy across programmes HR and governance challenges at National & County level

16 Recommendations Resource mobilization (domestic and external) for key HI interventions- Leveraging of Resources from: Partners including GFF & Global fund Equity focused programming- strengthening data availability and use for programming / decision